| NAME |
ADALIMUMAB 40MG/0.4ML X 1/80MG/0.8ML X 1 INJ,SYRINGE,KIT |
| VA GENERIC NAME |
ADALIMUMAB |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Adalimumab_(Humira)_(Oct_2018).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to providers appropriate for prescribing TNF inhibitors
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
ADALIMUMAB INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-06-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ADALIMUMAB 40MG/0.4ML/80MG/0.8ML/INJ KIT |
| VA PRODUCT IDENTIFIER |
A1973 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037537 |
| EFFECTIVE DATE/TIME |
-
- 2018-05-11 00:00:00
- STATUS: ACTIVE
|
